Mental Health and Mental Illness in America: Understanding, Causes, and Treatment

1. Anita Sego Spring, 2005

2. Chapter Objectives • Define mental health and mental disorders. • Explain what is meant by the DSM-IV-TR. • Identify the major causes of mental disorders. • Explain why mental health is on of the major community health problems in the United States.

3. Chapter Objectives • Define stress and explain its relationship to physical and mental health. • Briefly trace the history of mental health care in America, highlighting the major changes both before and after World War II. • Define the term deinstitutionalization and list and discuss the propelling forces that brought it about.

4. Chapter Objectives • Describe the movement toward community mental health centers. • Explain what is meant by Community Support Program and list some of the services provided by successful programs. • Identify the major mental and physical problems of the homeless. • Define primary, secondary, and tertiary prevention as they relate to mental health care services.

5. Chapter Objectives • List and briefly describe the three basic approaches to treatment for mental disorders. • Define self-help groups, give examples, and explain how they are helpful to their members. • Explain the purpose of the Substance Abuse and Mental Health Services Administration.

6. Chapter Objectives • Define what is meant by behavioral health care services. • Explain what is at issue when the term parity in health care services is used in reference to health care services for the mentally ill.

7. Introduction • Mental illness is major community health issue • 22-23% of American Adults • 6% addictive behaviors • small portion of those diagnosed receive treatment

8. Mental Health state of successful performance of mental function, resulting in productive activities, fulfilling relationships with other people, and the ability to adapt to change and to cope with adversity. Characteristics Function under adversity Change or adapt to changes around them Maintain control over their tension and anxiety Find more satisfaction in giving than receiving Show consideration for others Curb hate and guilt Love others Community Mental Health

9. Mental Illness • Mental disorders • health conditions that are characterized by alterations in thinking, mood, or behavior associated with distress and/or impaired functioning. • Classification • DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th edition) • Type of Onset • Severity

10. Childhood Organic mental disorders Psychological substance use Schizophrenia Mood disorders Mental retardation; attention-deficit hyperactivity disorder Alzheimer’s disease; dementia associated alcoholism or chronic drug use Alcohol, nicotine, cocaine, or other drug Paranoid schizophrenia Major depression; bipolar disorder Diagnostic Categories

11. Origins & Causes of Mental Disorders • Deficiency at Birth • Physical impairment • Idiopathic • Environmental • Inherited (Genetic) • Maternal exposure • physical agents • chemical agents • biological agents

12. Mental Illness In America • Statistical Indicators • between 15.4% of adults have had at least one episode of a mental disorder in the past 30 days • About 35% of the population aged 15-54 have had a mental disorder.

13. Mental Illness In America • Social Indicators • Homicides: 2nd leading cause of death in 15-24 age group • Suicides: 3rd leading cause of death in 15-24 age group • There are nearly 30,000 suicides each year • High rate of divorce • current widespread abuse of alcohol & tobacco

14. Mental Illness In America • Stress • one’s psychological & physiological response to stressors • General Adaptation Syndrome • alarm reaction • resistance • exhaustion • Diseases of Adaptation

15. General Adaptation Syndrome Alarm reaction Body is modified to defend against the stressor Stage of resistance Arousal remains high, as body tries to defend against & adapt to the stressor. Stage of exhaustion Resource are very limited; ability to resist may collapse Perceived stressor

16. Asthma Cancer Depression Dysmenorrhea Exhaustion Hypertension Gastrointestinal problems Coronary heart disease Inflammatory bowel disease Skin disorders Headaches Psychophysiological DisordersAssociated with Stress

17. History of Mental Care In America • Colonial America • 19th Century • Moral Treatment Era • State supported hospitals • Dorothea Dix (1802-1897) • Number of state hospitals grew rapidly last 25 years of 19th century

18. History of Mental Care In America • 1900 - 1920: Mental Hygiene Movement • Early identification and treatment (acute care) for those with mental illness to preclude the use of state hospitals • Dr. Adolf Meyer (1866-1950) • Clifford Beers ((1876-1943) • Mental Health in the 1920s and 1930s • Conditions in state mental hospitals continued to decline • First mention of deinstitutionalization

19. History of Mental Care In America • World War II • State hospitals continued to deteriorate • 15 million men were rejected from service for mental retardation and mental illness • Virtually all psychiatrists were drafted • New methods and drugs were developed • National Mental Health Act of of 1946 • National Institute of Mental Health was established • People began to realize the plight of the state mental hospitals

20. History of Mental Care In America • 1950s: Era of Deinstitutionalization • economics • idealism • legal considerations • antipsychotic drugs

21. History of Mental Care In America • Mental Health Care in the 1960s • Community Mental Health Centers Act - 1963 • Medicare & Medicaid - 1966 • transinstituionalized

22. History of Mental Care In America • Mental Health Care in the 1970s and 1980s • Recognition of the failure of CMHCs to meet the needs of the deinstitutionalized mentally ill • Initiation of Community Support Programs to promote recovery in persons with serious and persistent mental disorders

23. History of Mental Care In America • Mental Health Care in the 1990s • We were still dealing with the legacy of deinstitutionalization: homeless people with mental disorders • Continued absence of a comprehensive , coordinated system • Broadening access to treatment • Problems of Homelessness • Mental health problems • Physical health problems

24. Meeting the Needs of the Mentally Ill • Prevention • Primary Prevention: Efforts aimed at forestalling the onset of mental illness • Secondary Prevention: Reducing the prevalence by shortening episodes • Tertiary Prevention: treatment, and rehabilitation to ameliorate the illness and prevent further problems for the individual and the community. • Prevention Services

25. Meeting the Needs of the Mentally Ill • Treatment approaches • Goals • reduce symptoms • improve personal and social functioning • develop and strengthen coping skills • promote behaviors that improve life • Psychotherapy • Psychopharmacology • Self-Help Support Groups

26. Non-governmental Agencies • National Alliance for the Mentally Ill • founded 1979 • 856 affiliates & more than 20,000 member families • believe only biologically grounded treatment approaches are relevant • Alcoholics Anonymous

27. Federal Agencies • U.S. Public Health Service, SAMHSA • The Center for Substance Abuse Treatment • The Center for Substance Abuse Prevention • Center for Mental Health Services

28. Future Challenges • Managed Care Organizations (MCOs) • Evidenced-based medicine • Cost containment • “behavioral health care services” MBHOs • Parity Issue • 1996 Mental Health Parity Act • There is still not full parity in health care coverage between general health care services and mental (behavioral) health care services

29. Chapter 11 Community Mental Health